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Virtual Outpatient Heart Failure Care - Lessons From the Covid-19 Era
#MMPMIDC7527184
Ugolini S
; Mondesir FL
; Maires C
; Davis E
; Andrews H
; White C
; Anderson J
; Fetzer J
; Waldron J
; Shah K
; Wever-Pinzon O
; Nativi-Nicolau J
; Kemeyou L
; Gilbert EM
; Drakos S
; Fang JC
; Stehlik J
J Card Fail
2020[Oct]; 26
(10
): S5
PMIDC7527184
show ga
BACKGROUND: The COVID-19 pandemic disrupted the way care is delivered to patients
with chronic conditions such as heart failure (HF). Many outpatient encounters
are now conducted virtually via telehealth. Whether virtual visit for HF results
in similar type of interventions as when the patient is seen in person is not
known. METHODS: Starting on March 15, 2020, all non-time sensitive outpatient
in-person appointments at our institution were cancelled and transitioned to
virtual appointments where possible. We included all patients seen in a tertiary
care HF clinic from February 18 to March 13 (pre-Covid) and from March 16 to May
15 (post-COVID). We examined the volume of in-person and virtual visits and
compared medication titration rates pre- and post-COVID. RESULTS: The study
cohort included 745 patients, mean age 60.7+/-15.3 years, 65.2% male, 80.9%
Caucasian, 7.7% Hispanic/Latino. Of these, 227 patients were seen pre-COVID and
518 post-COVID. All appointments were in-person pre-COVID. After the change, only
18% of appointments were in-person while 82% were virtual. Outpatient volume
decreased after March 15, but gradually increased, eventually to volumes that
exceeded pre-COVID (Figure). Detailed results on medication titration are shown
in Table. Diuretic titration took place in 33/227 (14.5%) of patients pre-COVID
and 83/518 (16.0%) post-COVID (p=NS). Among 567 patients with HF with reduced
ejection fraction (HFrEF), titration of guideline-directed medical therapy (GDMT)
took place in 86/172 (50.0%) of patients pre-COVID and 159/395 (40.2%) post-COVID
(p=0.03). Among the 395 HFrEF patients seen post-COVID, GDMT was titrated in
33/68 (48.5%) patients seen in person and 126/327 (38.5%) seen virtually -
p=0.13. Barriers to medication titration in virtual visits were lack of blood
pressure readings and lack of recent laboratory results. CONCLUSION: Telehealth
has become an essential method of outpatient care delivery for chronic HF. Once
implemented, it offered efficiencies including improved access to the HF clinic
thanks to higher throughput capacity compared to physical clinic space. However,
we identified that GDMT titration took place less frequently than during
in-person visits. Since it is anticipated that telehealth use will continue into
the future, approaches to maximize GDMT in the absence of traditional direct
physical contact with HF patients are needed.
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